Gardner fibroma
Gardner fibroma | |
---|---|
Other names | Gardner-associated fibroma |
Specialty | Pediatrics, Dermatology, Pathology, Surgical oncology |
Symptoms | Typically a painless tumor in the skin |
Usual onset | All ages but mostly in the first decade of life |
Types | May be an isolated disorder or a manifestation of the genetic disease, adenomatous polyposis coli |
Treatment | Surgical resection and follow-up testing for the presence or development of adenomatous polyposis coli |
Frequency | Rare |
Gardner fibroma (GF) (also termed Gardner-associated fibroma
In the majority of cases,
There are no large studies that clearly define the best treatment(s) for Gardner fibroma tumors. Common treatment strategies for these tumors include: surgical removal;[1] evaluations of the individuals bearing these tumors as well as their family members for evidence of FAP; genetic counseling; and long-term follow-up studies to detect evidence of FAP and recurrences of resected tumors.[1][2][10]
Presentation
GF tumors typically present as a single but in some cases multiple plaques (i.e. papule-like masses that are 10 mm or more in longest diameter)[6] located on the skin of the back or, less commonly, head, neck, extremities, or abdominal regions.[1] In one study, the tumors ranged form 0.3 to 12 cm in greatest dimension (mean: 3.9 cm).[1] GF plaques on the skin are generally white, rubbery,[9] painless masses[6] that occur mainly in children during the first decade of life[9] but have also been diagnosed in adults as old as 59 years.[3] Rare cases of CF have presented as large masses located in the: mediastinum, i.e. central compartment of the thoracic cavity (a mediastinal GF has caused the life-threatening superior vena cava syndrome);[4] retropharyngeal space, i.e. space behind the pharynx and upper esophagus (a retropharyngeal GF tumor has caused airway obstruction);[11] retroperitoneal space;[3] and mesentery.[9]
The majority of individuals presenting with GF tumors have or will develop FAP due to mutations in the
FAP is an
Desmoid tumors may arise sporadically[1] or in 5–10% of cases in association with FAP.[15] In sporadic cases, these tumors occur most frequently in the abdominal wall, intra-abdominal cavity, and limbs.[15] They also arise as natural progressions of GF tumors,[13] that follow trauma to GF tumors, or that recur in surgically removed GF tumors; these progressions are sometimes termed the "GF–DF sequence".[6] DTs that replace GF tumors are benign but typically are rapidly growing, painful, tend to infiltrate into nearby tissues, and after their surgical removal often recur at the surgical sites. Desmoid tumors that are not associated with FAP almost always have tumor cells that express mutations in the CTNNB1 gene. This gene directs the production of catenin beta-1 protein and when mutated in desmoid tumor cells overproduces a fully active product protein that contributes to the unregulated growth of its parent cells.[15]
Individuals presenting with a GF (or DT) should be assessed for the presence of other FAP lesions such as colon and rectal polyps as well as for a family history of FAP and for family members with FAP-like lesions in order to determine if these individuals' GF tumors may or are due to FAP.[9]
Pathology
Microscopic
Similar examinations of desmoid tumor tissues reveal a heterogeneous, poorly defined and uniform proliferation of spindle-shaped myofibroblast-like cells (i.e. cells with combine some of the microscopic appearance features of fibroblasts and
Diagnosis
The diagnosis of GF depends on: its clinical presentation, i.e. occurrence as solitary plaque-like skin lesions that are located in the dermis of children; patient histories of previously having a GF tumor that was surgically removed;[1][15] characteristic histopathology findings;[3] tumor cell expressions of CD34[15] and β-catenin proteins[2] but not smooth muscle actin;[13] and the presence of other lesions associated with FAP, a family history of FAP, and/or family members with a history of FAP-like lesions.[9]
Treatment and prognosis
Isolated Gardner fibromas are commonly treated by surgical resection.[1][7] However, systematic examinations on the clinical value of this surgery have not been published. In one study of patients with mixed GF-DT tumors, the average time of recurrence after surgical removal was ~2.5 years for tumors located in the legs, arms, or deep soft tissues of the back and chest wall and ~5 years for tumors located in other sites. In this study, individuals with pure desmoid tumors, i.e. tumors with no areas with the histopathology of Gardner tumors, had an averaged recurrence time of >25 years.[7]
Individual cases of highly aggressive, symptomatic, and/or repeatedly recurring tumors diagnosed as DT but likely including GF-DT tumors have been treated with
Additional recommendations for individuals diagnosed with Gardner fibromas include: 1) long-term follow-ups to check for recurrent disease and the development of other FAP lesions;[1] 2) genetic counseling;[2] 3) mandatory screening (e.g. colonoscopy) for FAP every 6[10] or 12 months;[14] and 4) surveillance of the individual's parents, siblings, and children for the presence and development of FAP-associated lesions.[9]
References
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